Sugammadex efficacy for reversal of rocuronium- and vecuronium-induced neuromuscular blockade: A pooled analysis of 26 studies.

Autor: Herring WJ; Merck & Co., Inc., Kenilworth, NJ, USA. Electronic address: William_Herring@merck.com., Woo T; Merck & Co., Inc., Kenilworth, NJ, USA., Assaid CA; Merck & Co., Inc., Kenilworth, NJ, USA., Lupinacci RJ; Merck & Co., Inc., Kenilworth, NJ, USA., Lemmens HJ; Stanford University School of Medicine, Stanford, CA, USA., Blobner M; Klinik für Anaesthesiologie der Technischen Universität, Munich, Germany., Khuenl-Brady KS; Medical University Innsbruck, Innsbruck, Austria.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2017 Sep; Vol. 41, pp. 84-91. Date of Electronic Publication: 2017 Jul 15.
DOI: 10.1016/j.jclinane.2017.06.006
Abstrakt: Study Objective: To summarize and compare efficacy of sugammadex with neostigmine or placebo for reversal of rocuronium- or vecuronium-induced neuromuscular blockade (NMB), and to demonstrate consistency of sugammadex results across various patient populations.
Design: Pooled analysis on data from 26 multicenter, randomized, Phase II and III studies.
Setting: Operating room.
Patients: 1855 adults undergoing surgery under general anesthesia and receiving rocuronium or vecuronium for NMB.
Interventions: Sugammadex (2.0mg/kg at second twitch reappearance [T 2 ; moderate NMB], 4.0mg/kg at 1-2 post-tetanic counts [PTC; deep NMB] or 16.0mg/kg at 3min after rocuronium 1.2mg/kg), neostigmine or placebo.
Measurements: Time to recovery of the train-of-four (TOF) ratio to 0.9.
Main Results: Geometric mean (95% CI) times to recovery to TOF ratio of 0.9 were 1.9 (1.8-2.0) min following sugammadex 2.0mg/kg and 10.6 (9.8-11.6) min following neostigmine administration at T 2 after rocuronium, and 2.9 (2.5-3.4) min and 17.4 (13.4-22.6) min, respectively, after vecuronium. Recovery times were 2.2 (2.1-2.3) min following sugammadex 4.0mg/kg and 19.0 (14.8-24.6) min following neostigmine administered at a target of 1-2 PTC after rocuronium, and 3.8 (3.0-5.0) min and 67.6 (56.3-81.2) min after vecuronium. Sugammadex administered 3min after rocuronium 1.2mg/kg resulted in rapid recovery (1.7 [1.5-2.0] min). Modest increases in mean recovery time were associated with vecuronium use (+1.6min [78%; (61%-98%)] versus rocuronium), mild-to-moderate renal impairment (+0.4min [20%; (9%-32%)] versus normal renal function) and geographic location (+1.0min [38%; (25%-52%)] in subjects in USA/Canada versus Europe/Japan).
Conclusions: Sugammadex administered at recommended doses provides rapid and predictable reversal of rocuronium and vecuronium-induced moderate and deep NMB, and effective reversal 3min after rocuronium 1.2mg/kg. Robust recovery was seen across various patient factors, providing further confirmation of labeled dose recommendations.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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